THERAPEUTIC COMMUNICATION

M E D I C A L T H E R A P E U T I C S

C O M M U N I C AT I O N U N I T

BELL WORK

• Research and define the meaning of therapeutic communication.

• What does it mean to build rapport with someone?

STANDARDS

• 4) Evaluate factors that contribute to effective communication and explain how these factors

contribute to the development of quality patient care. Using role-play, demonstrate practices

to effectively manage communication barriers, cultural differences and clients with special

needs.

• 5) Differentiate between verbal and nonverbal communication when interacting with patients.

Examine specific techniques for effective communication and evaluate how different cultures

attach different meanings to communication techniques.

OBJECTIVES

• Define and explore therapeutic communication techniques.

• Identify “blocks” to therapeutic communication.

• Analyze role-playing examples of therapeutic communication and non-therapeutic

communication.

• Practice therapeutic communication techniques with a partner.

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Active Listening– Being attentive to what the client is saying,

verbally and non-verbally. Sit facing the client, open posture, lean

toward the client, eye contact, and relax.

• Sharing Observations– Making observations by commenting on

how the other person looks, sounds, or acts. Example: “you look

tired” or “I haven’t seen you eating anything today”.

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Sharing Empathy– The ability to understand and accept another

person’s reality, to accurately perceive feelings, and to communicate

understanding. Example “It must be very frustrating to know what

you want and not be able to do it”.

• Sharing Hope– Communicating a “sense of possibility” to others.

Encouragement when appropriate and positive feedback. Example “I

believe you will find a way to face your situation, because I have

seen your courage in the past”.

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Sharing Humor– Contributes to feelings of togetherness, closeness

and friendliness. Promotes positive communication in the following

ways: prevention, perception, perspective.

• Sharing Feelings– Nurses can help clients express emotions by

making observations, acknowledging feelings, and encouraging

communication, giving permission to express “negative” feelings and

modeling healthy anger.

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Using Touch– Most potent form of communication. Comfort touch

such as holding a hand, is especially important for vulnerable clients

who are experiencing severe illness.

• Silence– Time for the nurse and client to observe one another, sort

out feelings, think of how to say things, and consider what has been

verbally communicated. The nurse should allow the client to break

the silence.

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Providing Information– Relevant information is important to make decisions,

experience less anxiety, and feel safe and secure. Example “Susie is getting an

echocardiogram right now which is a test that uses painless sound waves to

create a moving picture of her heart structures and valves and should tell us

what is causing her murmur”.

• Clarifying– To check whether understanding is accurate, or to better

understand, the nurse restates an unclear or ambiguous message to clarify the

sender’s meaning. “I’m not sure I understand what you mean by ‘sicker than

usual’, what is different now?”

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Focusing– Taking notice of a single idea expressed or even a single

word. An example is “On a scale of 0 to 10 tell me the level of the

pain you are experiencing in your great toe right now.”

• Paraphrasing– Restating another’s message more briefly using one’s

own words. It consists of repeating in fewer and fresher words the

essential ideas of the client. For example the client says “I can’t

focus. My mind keeps wandering.” The student nurse says,” You’re

having difficulty concentrating?”

TECHNIQUES OF THERAPEUTIC COMMUNICATION• Asking Relevant Questions– To seek information needed for decision making. Asking only one

question at a time and fully exploring one topic before moving to another area. Open-ended

questions allows for taking the conversational lead and introducing pertinent information about a

topic. For example “What is your biggest problem at the moment?” or “How has your pain

affected your life at home?”

• Summarizing– Pulls together information for documentation. Gives a client a sense you

understand. It is a concise review of key aspects of an interaction. Summarizing brings a sense of

closure. Example “It is my understanding that your arm pain is a level 1 since you’ve taken a

Vicodin one hour ago. Taking your pain medication before physical therapy seems to help you

complete the activities the doctor wants you to do for your rehabilitation. Is this correct?” Client

responds “Yes It really helps to take the medicine before I do my physical therapy because it helps

reduce the pain in my arm.”

TECHNIQUES OF THERAPEUTIC COMMUNICATION

• Self-Disclosure– Subjectively true personal experiences about the self, are

intentionally revealed to another person for the purpose of emphasizing both the

similarities and the differences of experiences. These exchanges are offered as an

expression of genuineness and honestly by the nurse and disclosures should be

relevant and appropriate. They are used sparingly so the client is the focus of the

interaction: “That happened to me once, too. It was devastating, and I had to face

some things about myself that I didn’t like. I went to counseling and it really

helped.....what are your thoughts about seeing a counselor?”

• Confrontation– Helping the client become more aware of inconsistencies in his

or her feelings, attitudes, beliefs, and behaviors. Only to be used after trust has

been established, & should be done gently, with sensitivity: “You say you’ve already

decided what to do, yet you’re still talking a lot about your options.”

BLOCKS

• Asking personal questions – Asking person questions that are not relevant to the situation, is not

professional or appropriate. Don’t ask questions just to satisfy your curiosity. “Why aren’t you

married to Mary?” is not appropriate. What might be asked is “How would you describe your

relationship to Mary.

• Giving personal opinions– Giving personal opinions, takes away decision-making for the client.

Remember the problem and the solution belongs to the patient and not the nurse. “If I were you I’d

put your father in a nursing home” can be reframed to say,” Let’s talk about what options are

available to your father.”

• Changing the subject– “Let’s not talk about your insurance problems it’s time for your walk”

Changing the subject when someone is trying to communicate with you is rude and shows a lack of

empathy. It ends to block further communication, and seems to say that you don’t really care about

what they are sharing. “After your walk let’s talk some more about what’s going on with your

insurance company.”

BLOCKS

• Automatic responses– “Administration doesn’t care about the staff,” or “Older

adults are always confused.” These are generalizations and stereotypes that

reflect poor nursing judgment and threaten nurse-client or team relationships.

• False Reassurance– “Don’t worry, everything will be all right.” When a client is

seriously ill or distressed, the nurse may be tempted to offer hope to the client

with statements such as “you’ll be fine.” Or “there’s nothing to worry about.”

When a patient is reaching for understanding these phrases that are not based

on fact or based on reality can do more harm than good. The nurse may be

trying to be kind and think he/she is helping, but these comments tend to block

conversation and discourage further expressions of feelings. A better response

would be “It must be difficult not to know what the surgeon will find. What can

I do to help?”

BLOCKS• Sympathy– Sympathy focuses on the nurse’s feelings rather than the client’s.

Saying “I’m so sorry about your amputation, it must be terrible to lose a leg.”

This shows concern but more sorrow and pity than trying to understand how

the client feels. Sympathy is a subjective look at another person’s world that

prevents a clear perspective of the issues confronting that person. A more

empathetic approach would be “The loss of your leg is a major change, how do

you think this will affect your life?”

• Asking for Explanations– “Why are you so upset?” A nurse may be tempted to

ask the other person to explain why the person believes, feels or is acting in a

certain way. Clients frequently interpret why questions as accusations. “Why”

questions can cause resentment, insecurity and mistrust. It’s best to phrase a

question to avoid using the word “why”. “You seem upset. What’s on your

mind?”

BLOCKS

• Approval or Disapproval–“You shouldn’t even think about assisted suicide, it’s

just not right.” Nurses must not impose their own attitudes, values, beliefs, and

moral standards on others, while in the professional helping role. Judgmental

responses by the nurse often contain terms such as should, ought, good, bad,

right or wrong. Agreeing or disagreeing sends the subtle message that nurses

have the right to make value judgments about the client’s decisions. Approving

implies that the behavior being praised is the only acceptable one.

Disapproving implies that the client must meet the nurse’s expectations or

standards. Instead the nurse should help clients explore their own beliefs and

decisions. The nursing response “I’m surprised you are considering assisted

suicide. Tell me more about it...” gives the client a chance to express ideas or

feelings without fear of being judged.

BLOCKS• Defensive Responses– “No one here would intentionally lie to you.” When clients express

criticism, nurses should listen to what they are saying. Listening does not imply agreement. To

discover reasons for the client’s anger or dissatisfaction, the nurse must listen uncritically. By

avoiding defensiveness the nurse can defuse anger and uncover deeper concerns: “You believe

people have been dishonest with you. It must be hard to trust anyone.”

• Passive or Aggressive Responses– “Things are bad and there is nothing you can do about it.” Or

“Being is sick is bad and it’s all your fault.” Passive responses serve to avoid conflict or sidestep

issues. They reflect feelings of sadness, depression, anxiety, powerlessness, and hopelessness.

Aggressive responses provoke confrontation at the other person’s expense. They reflect feelings

of anger, frustration, resentment and stress. Assertive communication is a far more professional

approach for the nurse to take.

• Arguing– “How can you say you didn’t sleep a wink when I heard you snoring all night long!!”

Challenging or arguing again perceptions denies that they are real and valid to the other person.

They imply that the other person is lying, misinformed, or uneducated. The skillful nurse can

provide information or present reality in a way that avoids argument: “You feel like you didn’t get

any rest at all last night, even though I thought you slept well since I heard you snoring.”

THERAPEUTIC COMMUNICATION VIDEO WITH GUIDED NOTES

• https://www.youtube.com/watch?v=W54yhhZ9DOQ (9 minutes)

The handout will give you questions and prompts to consider for

therapeutic and non-therapeutic communication.

Take as many notes as you can.

We will discuss after class.

GROUP ACTIVITY

• Work with your partner to decide how to communicate one of the following two procedures to a patient that is blind.

• Chest tube- This patient has a pleural effusion following heart bypass surgery.

• PICC line-This patient will be leaving the hospital with this special IV to receive antibiotics from a home health nurse.

• You will read the procedure information I gave you and then decide how you would effectively communicate with the patient.

• One of you will pretend to be the healthcare professional and one of you will pretend to be the patient.

• The healthcare professional needs to explain the reason for the procedure as well as the steps taken to perform the procedure.

• The patient needs to “play the part” and ask questions, act, and react in the conversation.

• (We already have consent by the way!!!)

BELL WORK DAY 2

• Review the notes your took yesterday.

• Individual Analysis:

• Which of the therapeutic techniques will be the easiest for you to apply?

• Which of the therapeutic techniques will be the most challenging for you to apply?

• Which of the blocks would you struggle with avoiding? Why?

OBJECTIVES

• Define palliative care and relate it to medical therapeutics.

• Examine case studies of palliative care patients.

• Identify the therapeutic communication techniques used by certified palliative care specialists.

• Analyze a professional journal related to effective communication in the hospital setting.

WHAT IS PALLIATIVE CARE?

• Research and define what “palliative” patient care is? Are there healthcare professionals that

specialize in this?

• Take notes as we follow along with the following videos.

• Case Study One

• https://www.youtube.com/watch?v=jaB9M8B_Tuw&t=3s (5 min)

• Case Study Two

• https://www.youtube.com/watch?v=N4objV7cLYg&t=6s&list=FLERstYMA_-qq13Plc8ZV--

g&index=65 (3 min)

• Ten Steps for What to Say and Do

• https://www.youtube.com/watch?v=7kQ3PUyhmPQ (6 min)

DIRECTED READING ASSIGNMENT

• Patient Care and Communication in the Mammography Suite

Read the directed reading and answer the questions.

EXIT TICKET

• What are some examples of therapeutic communication?

• Explain why therapeutic communication is vital to patient care.